HOME: THE JOHN LAVERTY, JR. CASE-- FALSE SBS CHARGES, WRONGFUL CONVICTION & IMPRISONMENT

THE "SHAKEN BABY SYNDROME" MYTH: Why top scientists say it isn't possible to shake an infant hard enough to cause the symptoms used to diagnose SBS and the probable real causes

No More SHAKEN BABY SYNDROME. Now it's Shaken impact.

On April 27, 2009, the American Academy of Pediatrics published a new policy
statement in their medical journal, "Pediatrics", described as "the peer-reviewed,
scientific journal of the America Academy of Pediatrics (AAP):

ABUSIVE HEAD TRAUMA: A NEW NAME FOR SHAKEN BABY SYNDROME
"Shaken baby syndrome is a term often used by doctors and the public to describe abusive head trauma inflicted on infants and young children. While shaking an infant can cause neurologic injury, blunt impact or a combination of shaking and blunt impact can also cause injury. In recognition of the need for broad medical terminology that includes all mechanisms of injury, the new AAP policy statement, “Abusive Head Trauma In Infants and Children,” recommends pediatricians embrace the term “abusive head trauma” to describe an inflicted injury to the head and its contents. Pediatricians should learn to recognize the signs and symptoms of abusive head trauma, including those caused by both shaking and blunt impact, and consult with pediatric sub specialists when necessary. "

http://jama.ama-assn.org/content/181/1/17.short (abstract only)

JAMA. 1962;181(1):17-24. doi: 10.1001/jama.1962.03050270019004

The Battered-Child Syndrome

C. Henry Kempe, M.D.;
Frederic N. Silverman, M.D.;
Brandt F. Steele, M.D.;
William Droegemueller, M.D.;
Henry K. Silver, M.D.

Denver; Cincinnati; Denver
Professor and Chairman (Dr. Kempe) and Professor of Pediatrics (Dr. Silver), Department of Pediatrics; Associate Professor of Psychiatry (Dr. Steele), and Assistant Resident in Obstetrics and Gynecology (Dr. Droegemueller), University of Colorado School of Medicine; and Director, Division of Roentgenology, Children's Hospital (Dr. Silverman).

Abstract

The battered-child syndrome, a clinical condition in young children who have received serious physical abuse, is a frequent cause of permanent injury or death. The syndrome should be considered in any child exhibiting evidence of fracture of any bone, subdural hematoma, failure to thrive, soft tissue swellings or skin bruising, in any child who dies suddenly, or where the degree and type of injury is at variance with the history given regarding the occurrence of the trauma. Psychiatric factors are probably of prime importance in the pathogenesis of the disorder, but knowledge of these factors is limited. Physicians have a duty and responsibility to the child to require a full evaluation of the problem and to guarantee that no expected repetition of trauma will be permitted to occur.

 

The Origin of Shaken Baby Syndrome: An Unproven Hypothesis Accepted As Medical Theory Without A Scientific Basis. Caffey's first article was published in 1972. this is the second of his two articles that created the junk science foundation of Shaken Baby Syndrome.

John Caffey, Radiologist: Whiplash-shaken Baby Syndrome
PEDIATRICS Vol. 54 No. 4 October 1974, pp. 396-403

The Whiplash Shaken Infant Syndrome: Manual Shaking by the Extremities With Whiplash-Induced Intracranial and Intraocular Bleedings, Linked With Residual Permanent Brain Damage and Mental Retardation
John Caffey M.D.1

1 Departments of Radiology and Pediatrics, University of Pittsburgh School of Medicine, and the Children's Hospital of Pittsburgh

Our evidence, both direct and circumstantial, indicates that manual whiplash shaking of infants is a common primary type of trauma in the so called battered infant syndrome. It appears to be the major cause in these infants who suffer from subdural hematomas and intraocular bleedings. The label "battered infant" is a misnomer in many cases which may interfere with early diagnosis and proper preventive treatment.

The essential elements in the infantile whiplash shaking syndrome present an extraordinary diagnostic contradiction. They include intracranial and intraocular hemorrhages, in the absence of signs of external trauma to the head or fractures of the calvaria, and are associated with traction lesions of the periosteums of the long bones in the absence of fractures and traumatic changes in the overlying skin of the extremities. Usually there is no history of trauma of any kind.

Habitual, prolonged, casual whiplash shakings may produce an insidious progressive clinical picture, the latent whiplash shaken infant syndrome, which is often in apparent to both parents and physicians. It usually first becomes evident at school age when minor idiopathic cerebral motor defects are first detected along with mild idiopathic mental retardation. Permanent impairments of vision and hearing may also be identified at this time for the first time when the children are 5 to 6 years of age. The actual number of such cases is incalculable from current evidence but it appears to be substantial.

This concept of the whiplash shaken infant syndrome warrants careful diagnostic consideration in all infants with unexplained convulsions, hyperirritability, bulging fontanel, paralyses, and forceful vomiting singly or in combination. The routine careful examination of the ocular fundi of all infants should provide a superior screening method for early and massive detection of pathogenic whiplash shakings along with radiographic examination of the long bones for confirmation in appropriate cases.

Current evidence, though manifestly incomplete and largely circumstantial, warrants a nationwide educational campaign on the potential pathogenicity of habitual, manual, casual whiplash shaking of infants, and on all other habits, practices and procedures in which the heads of infants are habitually jerked and jolted (whiplashed).

The proposed nationwide educational campaign against the shaking, slapping, jerking, and jolting of infants' heads is summarized in the following stanza:

Guard well your baby's precious head,

Shake, jerk and slap it never,

Lest you bruise his brain and twist his mind,

Or whiplash him dead, forever.
Submitted on April 13, 1973
Accepted on May 7, 1974

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World-renowned Vitamin C Deficiency Expert Analyzes Dr. Caffey's False Hypothesis

Caffey Revisited: A Commentary on the Origin of
“Shaken Baby Syndrome”

Clemetson on Caffey

C. Alan B. Clemetson, M.D.
Journal of American Physicians and Surgeons Volume 11 Number 1 Spring 2006

ABSTRACT

Caffey is often cited as the source of the diagnosis of “shaken baby syndrome” (SBS). Once the “classic” findings attributed to SBS are identified, it is rare for a differential diagnosis to be considered.

Caffey focused on radiologic findings, but while he was aware of the possible diagnosis of scurvy, the radiologic signs of infantile scurvy may not have had sufficient time to develop. Other findings in his cases were compatible with scurvy due to toxic histaminemia, which can cause capillary fragility, retinal petechiae, and subdural hematoma. Although dietary vitamin C deficiency is very rare today in our country, both vitamin C deficiency and toxic histaminemia can accompany systemic infection. Toxic histaminemia may also occur following immunizations.

Skeletal Findings in Caffey's Cases

In 1946, John Caffey, a radiologist, described multiple fractures in the long bones of infants suffering from chronic subdural hematoma. None of the parents reported any knowledge of falls or physical injury, but Caffey suspected child abuse to explain the injuries.

Following this retrospective, radiological study by Caffey, the diagnosis of “shaken baby syndrome” (SBS—including retinal petechiae, multiple fractures of the long bones, and subdural hematomas) evolved and has resulted in many men and women being convicted of child abuse, all without any meaningful consideration of a differential diagnosis.

Although Caffey mentioned the word scurvy in the differential diagnosis of each of the six cases, he stated that none of the infants showed the typical radiological changes of scurvy: many of the
fractures were in the shafts of the long bones, instead of at the junctions between the epiphyses and the diaphyses. 

The radiologic signs of scurvy, however, are variable. The most consistent finding used to be elevation and calcification of the periosteum of the long bones due to subperiosteal hemorrhage, above and below the fracture sites. In reviewing Caffey’s six original cases, this finding was present in most of the cases. And, although osteopenia and contrasting white lines of healing are said to be characteristic radiological features of classical scurvy, absence of these findings on radiographs does not rule out a s scorbutic state.The precise time course of  increased susceptibility to fractures and the development of osteopenia and white lines of healing seen on radiographs is not known. Bones may be vulnerable to fracture because of proline and lysine hydroxylase deficiencies affecting chondroblasts and osteoblasts before these classic radiological signs appear, especially if scurvy develops rapidly at an early age.

Additional Findings in Caffey’s Case Studies

In addition to the long-bone fractures and subdural hematomas, other clinical signs consistent with infantile scurvy were evident in most of Caffey’s six cases:

Case 1. A purulent discharge from the right ear began at age 5 months and persisted for 2 months; a convulsion due to subdural
hemorrhage  occurred at 7months. Spontaneous fracture of the right radius occurred after nine days in the hospital.

Case 2. Convulsions began at age 1 month. At 7 months, the infant developed soft, spongy, bleeding gums typical of scurvy, and retinal petechiae indicative of increased capillary fragility. At age 8 months, he developed signs of subdural hematoma.

Case 3. Multiple fresh hemorrhages were present in both ocular fundi. Petechiae were also scattered on the abdominal wall, and a large ecchymosis was seen on the left side of the face.

Case 4. Radiographs showed evidence of epiphyseal separation at the proximal end of the right humerus, suggestive of scurvy.

Case 5. Subdural hematoma and bone fractures associated with otitis media were present; black-and-blue spots on the fore head and face could be interpreted as either traumatic or scorbutic.

Case 6. There was bilateral proptosis due to retrobulbar hemorrhages consistent with scurvy—akin to the unilateral proptosis seen in vitaminC-deficient18 century sailors.

Even with adequate dietary vitamin C intake, infections can rapidly deplete ascorbic acid stores and increase the blood histamine level. In cases 1 and 5 above, it is noted that subdural hemorrhages occurred in the context of on going otitis media infections.

Many factors affect vitamin C metabolism, but the most important is systemic infection. Hess, in his Cutter Lecture at Harvard Medical School, recognized that infection and vitamin C deficiency were both related to the development of infantile scurvy. It was a number of years, however, before he realized that each affected the other—vitamin C deficiency predisposes to infection, and infection predisposes to vitamin C deficiency. Blood levels of vitamin C are also inversely related to blood histamine levels.

Onset of Infantile Scurvy

Infantile scurvy used to occur most commonly after age 7 months, when swollen, bleeding gums were evident, as the lower incisor teeth had erupted and bacteria could enter the scorbutic gingival sulcus. In contrast, an earlier onset variant of infantile scurvy now occurs at 8 to12 weeks of age. Bleeding gums are rarely never seen before the eruption of the lower incisor teeth at 7 months, so the diagnosis of scurvy  may not be obvious.

The hypothesis that subdural hemorrhages, retinal petechiae, and spontaneous fractures of the ribs and long bones can occur as an early variant of scurvy at about 8 to 10 weeks of age has not been adequately studied, and, therefore, has not been disproven. Unless and until vitamin C and histamine levels are actually measured in these infants, who are automatically classified as victims of SBS, we will not know the truth about causation. Unfortunately, even if the diagnosis of infantile scurvy is considered, most hospitals do not have the ability to measure either vitamin C or histamine levels.

Gardner has observed that the age of onset of the diagnosis of so-called “shaken baby syndrome” is significantly later in Japan (peaking at 7 to 9 months) than in the United States (peaking at 2 to
4 months). Is this because Japanese infants are abused at a later age than American infants, or is there another explanation? Gardner noted that these ages correspond to the standard ages when
vaccinations have been given in the two countries, respectively.

A Multifactorial Cause?

Infants with the findings attributed to SBS may be affected by a combination of factors causing generalized capillary fragility, which in turn affects the capillaries of the bridging veins between
the brain and the dura mater—predisposing to subdural hematoma—due to inadequate ascorbic acid intake and/or depletion by infections or multiple immunizations.

The defective formation of fibrous tissue, bone, and dentin that is known to occur in scurvy results from proline and lysine hydroxylase deficiencies that affect fibroblasts, chondroblasts, osteoblasts, and ameloblasts. However, the increased capillary and venular fragility causing the bleeding associated with scurvy is due to a many-fold increase in the blood histamine level, as shown by Clemetson.  

The total blood histamine increases exponentially as the plasma ascorbic acid falls. Majno and Palade have shown that toxic levels of histamine in the blood cause openings in the tight
junctions between the vascular endothelial cells, leading to extravasation of blood. Leakage of blood into the tissue slowly leads to local hemolysis, as evidenced by the yellow color characteristic of the fluid of old subdural hematomas. Hemolysis also leads to local ascorbate depletion.

Chatterjee et al. reported increased blood histamine levels following vaccinations in guinea pigs. This effect would likely be heightened when six vaccinations are given at the same time at 8
weeks of age, such as is now the custom in most English-speaking countries. If vitamin C levels are low at the time of vaccination, a resulting toxic histaminemia may cause further clinical problems.

A relevant finding by Archie Kalokerinos is that the increased death rate following vaccination of Aboriginal infants in Australia was arrested by administering vitamin C at the time of vaccination—because ascorbic acid “detoxifies” histamine. Indeed, Chatterjee et al. demonstrated that ascorbic acid is essential for the detoxification of histamine (in guinea pigs), by converting it to hydantoin-5-acetic acid, and on to aspartic acid in vivo. Illustrations of the physiology and pathology of ascorbic acid and blood histamine have been presented previously.

Other factors that are not given sufficient weight in evaluations for SBS are the presence of chronic subdural hematomas, often occurring during or shortly after birth, and the fact that chronic
subdurals are susceptible to rebleeding. Subdural hematomas have been found using fetal ultrasound in utero, before labor, as reported by Gunn, and also following normal, spontaneous delivery, as reported by Chamnavanakietal. The tendency to rebleed could be exacerbated by toxic histaminemia through the mechanisms explained above.

More Research Needed

The effects of various vaccinations, given alone or together, on whole blood histamine levels and plasma ascorbic acid levels, should be further studied. Concerted research may increase our
understanding of the toxicity of different vaccines and the effects of giving single versus multiple, simultaneously administered vaccines. Their impact on vitamin C, histamine, and clinical
manifestations of deficiency/toxemia  must be assessed. It should be helpful to reduce the number of vaccines given simultaneously or in rapid succession.

A better understanding of these factors may help prevent adverse reactions following vaccinations. Dr. Kalokerinos has shown a clear benefit by providing supplemental vitamin C at the time of vaccination in some children. Vitamin C is an extremely safe substance—the only ill effects tend to occur in older children and adults who suffer from hemosiderosis due to sickle cell disease
or Mediterranean  anemia. Iron storage depletes ascorbic acid stores via oxidation and hydrolysis, and the dehydroascorbic acid so formed can be harmful. Even then, the toxic effect of vitamin C
may only be mild and temporary in young infants.

Conclusions

The so-called “classic” findings of subdural hematoma and retinal hemorrhages in infants, without any evidence of major trauma, do not always automatically equate to a diagnosis of
SBS. As in all other areas of medicine, it is prudent to do a differential diagnosis.

The findings in the cases that initially established SBS as a diagnosis were compatible with and even suggestive of infantile scurvy or toxic histaminemia.

C. Alan B. Clemetson, M.D., was Professor Emeritus, Tulane University school of Medicine, New Orleans, La. His people may be contacted by e-mail at megcc2000@yahoo.com (Dr. Clemetson passed away in 2006, but someone is still receiving his emails and responding.)

REFERENCES

1. Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural hematoma. 1946;56:163-173. Am J Roentgen Rad Ther
2. Hess AF. Nutritional disorders in the light of recent investigations.1922;207:101-108. Boston Med Surg J
3. Gardner HB. Retinal and subdural haemorrhages: Aoki revisited 2004;87:919-920.Brit J Ophthalmol
4. Gardner HB. Immunizations, retinal and subdural hemorrhages: are they related?
   2005;64:663-664. Med Hypotheses
5. Clemetson CAB. Histamine and ascorbic acid in human blood.1980;110:662-668.J Nutr
6. Majno G, Palade GE. Studies on inflammation. 1. The effect of histamine and serotonin on vascular permeability. An electron microscopic study 1961;11:571-605. J Biophys Biochem Cytol
7. Clemetson CAB. Hemolysis. In: vol 1. Boca Raton Fla.: CRC Press; 1989:181-192.Vitamin C
8. Chatterjee IB, Majumder AK, Nandi BK, Subramanian N. Synthesis and some major functions of vitamin C in animals 1975;258:24-47. Ann NY Acad Sci
9. Kalokerinos A. Sydney, Australia: Thomas Nelson; 1974. Every Second Child
10. Clemetson CAB. Was it “shaken baby” or a variant of Barlow’s disease? 2004;9:78-80. J Am Phys Surg
11. Gunn TR. Subdural hemorrhage in utero. 1985;76:605-610. Pediatrics
12. Chamnanvanaki S, Rollins N, Perlman JM. Subdural hematoma in term infants. 2002; 26:301-304. Pediat Neurol
13. Clemetson CAB. Heavy metals, water supplies: copper, iron, manganese, mercury, and cobalt. In: vol 1. Boca Raton Fla.: CRC Press; 1989:89-100.Vitamin C Journal of American Physicians and Surgeons Volume 11 Number 1 Spring 2006

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Spontaneous Or Accidental Causes of Subdural Hematomas

http://www.ajnr.org/cgi/content/abstract/27/8/1725

American Journal of Neuroradiology 27:1725-1728, September 2006
© 2006 American Society of Neuroradiology
PEDIATRICS
Subdural Hematomas in Infants with Benign Enlargement of the Subarachnoid Spaces Are Not Pathognomonic for Child Abuse

BACKGROUND AND PURPOSE: Patients who have benign enlargement of the subarachnoid spaces (BESS) have long been suspected of having an increased propensity for subdural hematomas either spontaneously or as a result of accidental injury. Subdural hematomas in infants are often equated with nonaccidental trauma (NAT). A better understanding of the clinical and imaging characteristics of subdural hematomas that occur either spontaneously or as a result of accidental trauma may help distinguish this group of patients from those who suffer subdural hematomas as a result of NAT. The purpose of this study is to describe the clinical and imaging characteristics of subdural hematomas that occur either spontaneously or as a result of accidental injury in infants with BESS.

RESULTS: During the study period, 7 patients with BESS complicated by subdural hematoma were identified. Their mean age at identification of the subdural hematoma was 7.4 months of age. In 5 cases, there was no recognized trauma before identification of the subdural hematoma. In 3 cases, baseline CT or MR imaging was available, showing prominent subarachnoid spaces without any evidence of subdural hemorrhage.

CONCLUSION: Although suspicious for NAT, subdural hematomas can occur in children either spontaneously or as a result of accidental trauma. Caution must be exercised when investigating for NAT based on the sole presence of subdural hematomas, especially in children who are otherwise well and who have BESS.

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Older Children With The Same Symptoms As Infants Assumed To Have Been Shaken: Discrediting Theories About "Shaken" Brain Injury In Infants Due To Weak Necks and Soft Brains (no neck injury means no shaking occurred)

http://pediatrics.aappublications.org/cgi/content/abstract/117/5/e1039

Published online May 1, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. e1039-e1044 (doi:10.1542/peds.2005-0811)

EXPERIENCE & REASON
Findings in Older Children With Abusive Head Injury: Does Shaken-Child Syndrome Exist?
Hani Salehi-Had, BAa, James D. Brandt, MDa, Angela J. Rosas, MDb and Kristen K. Rogers, PhDb

a Department of Ophthalmology, University of California Davis Medical Center, Sacramento, California
b Department of Pediatrics, Child and Adolescent Abuse Resource and Evaluation Diagnostic and Treatment Center, University of California Davis Children's Hospital, Sacramento, California

ABSTRACT

Shaken-baby syndrome (SBS) has been hypothesized to occur after shaking by an adult during the first 2 years of life. We wondered whether it is possible to achieve rotational forces sufficient to cause SBS-like injuries in children >2 years of age. The present study describes cases of child abuse in older children who presented with the classic ophthalmologic and intracranial findings of SBS. In this case series, 4 cases of older children (2.5–7 years old; 11.8–22 kg) who died from abusive head injuries and who had diffuse retinal hemorrhages identified antemortem were selected for review. The cases were abstracted from hospital charts, records from autopsies, coroners' and district attorneys' offices, and court transcripts. In all 4 cases the history provided by the primary caregiver did not match the severity of the injuries. Three case subjects presented with patterned bruises. Multilayered retinal hemorrhages and acute subdural hematoma were observed in all 4 cases. At autopsy, diffuse axonal injury was evident in 3 of the 4 cases; all 4 cases had optic nerve sheath hemorrhages. None of the victims had skeletal fractures on radiologic examination or at autopsy. This case series demonstrates that it is possible to observe SBS-like retinal and central nervous system findings in the older and heavier child. Our findings underscore the need for providers to consider intentional shaking as a mechanism of injury in the evaluation of abusive head injury in older children.

Accepted Nov 7, 2005.

Were these children shaken, or were they assumed to be shaken because of the symptoms?

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Wrongful Diagnosis

http://jrsm.rsmjournals.com/cgi/content/full/98/6/249

Wrongful diagnosis of child abuse—a master theory
Le Fanu J R Soc Med.2005; 98: 249-254

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How ASSUMPTIONS Are Accepted As Facts:

http://radiographics.rsnajnls.org/cgi/content/abstract/23/4/811

DOI: 10.1148/rg.234035030

(Radiographics. 2003;23:811-845.)

AFIP ARCHIVES
From the Archives of the AFIP
Child Abuse: Radiologic-Pathologic Correlation1
Gael J. Lonergan, Lt Col, USAF MC, Andrew M. Baker, MD, Mitchel K. Morey, MD and Steven C. Boos, Lt Col, USAF MC

1 From the Department of Radiologic Pathology, Armed Forces Institute of Pathology, 14th and Alaska Sts NW, Bldg 54, Rm M-121, Washington, DC 20306-6000 (G.J.L.); Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (G.J.L.); Hennepin County Medical Examiner’s Office, Minneapolis, Minn (A.M.B., M.K.M.); and Armed Forces Center for Child Protection, National Naval Medical Center, Bethesda, Md (S.C.B.). Received February 10, 2003; revision requested March 24 and received March 31; accepted April 4. Address correspondence to G.J.L. (e-mail: glonergan@mac.com).

In the United States, roughly one of every 100 children is subjected to some form of neglect or abuse; inflicted injury is responsible for approximately 1,200 deaths per year. Child physical abuse may manifest as virtually any injury pattern known to medicine.* Some of the injuries observed in battered children are relatively unique to this population (especially when observed in infants) and therefore are highly suggestive of nonaccidental, or inflicted, injury. Worrisome injuries include rib fracture, metaphyseal fracture, interhemispheric extraaxial hemorrhage, shear-type brain injury, vertebral compression fracture, and small bowel hematoma and laceration. As noted, however, virtually any injury may be inflicted; therefore, careful consideration of the nature of the injury, the developmental capabilities of the child, and the given history are crucial to determine the likelihood that an injury was inflicted. The majority of these injuries are readily detectable at imaging, and radiologic examination forms the mainstay of evaluation of child physical abuse. Detection of metaphyseal fracture (regarded as the most specific radiographically detectable injury in abuse) depends on high-quality, small field-of-view radiographs. The injury manifests radiographically as a lucent area within the subphyseal metaphysis, extending completely or partially across the metaphysis, roughly perpendicular to the long axis of the bone. Acute rib fractures (which in infants are strongly correlated with abuse) appear as linear lucent areas. They may be difficult to discern when acute; thus, follow-up radiography increases detection of these fractures. For skull injuries, radiography is best for detecting fractures, but computed tomography and magnetic resonance imaging best depict intracranial injury.

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Intracranial Hemorrhage Unrelated to Child Abuse

http://aapgrandrounds.aappublications.org/cgi/content/full/17/5/54

Neonatal Intracranial Hemorrhage May Be More Frequent than Previously Suspected
Wood AAP Grand Rounds.2007; 17: 54

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British Medical Journal Responses: SBS

http://www.bmj.com/cgi/eletters/328/7442/719 (response page)

Retinal haemorrhages and SBS. Fact or Fantasy?

Editor,

The Shaken Baby Syndrome (SBS) is receiving renewed attention by the Ophthalmology Child Abuse Working Party (OCAWP) deciding to develop new “guidelines” for the diagnosis of retinal haemorrhages associated with intracerebral haemorrhages.

The first essential of their endeavour should be to establish the validity of the diagnosis of SBS. Does such a condition exist or is it the diagnosis of those who “think dirty” when unable to explain a particular group of signs and symptoms in a child?

Of 21 cases of alleged child abuse sent to me for my opinion from four countries including the UK, USA and Australia, 16 had retinal, intracerebral and other haemorrhages with or without fractures.

All 16 were either vaccinated within 21 days of the onset of their symptoms or had documented evidence of a haemostatic, liver or nutritional disorder. All had a history of Apnoea at the onset of their symptoms.

If the OCAWP seek to guide the profession on the distinction between accidental and non-accidental retinal haemorrhages they must first document a SINGLE case of retinal haemorrhages associated with intracerebral haemorrhages that did not occur within 21 days of being vaccinated and had no evidence of a haematological, liver or nutritional disorder,

Since the authors declare they have served as expert witnesses in suspected non-accidental injury they will obviously have a number of cases upon which they can draw to produce just ONE ADEQUATELY INVESTIGATED CASE of SBS with none of the features mentioned above.

If between them they cannot produce a single case they should admit that the concept of Shaken Baby Syndrome is an aberration unworthy of inclusion in the Medical lexicon.

Michael D Innis MBBS; DTM&H; FRCPA; FRCPath.

Shaken baby syndrome or another diagnosis? 7 April 2004
Previous Rapid Response Next Rapid Response Top
Anne Marie Oudesluys-Murphy,
consultant paediatrician
Medisch Centrum Rijnmond-Zuid, 3075 EA, Rotterdam , The Netherlands,
Annemarie van Rossum

Send response to journal:
Re: Shaken baby syndrome or another diagnosis?

We read the recent papers and editorials on the shaken baby syndrome with great interest (1,2,3). These discuss the possible aetiology of this disorder, but fail to address the differential diagnoses which need to be taken into account when confronted with a baby with the findings of acute encephalopathy accompanied by subdural and retinal haemorrhages. In view of not only the medico-legal, but also the diagnostic and possible therapeutic aspects, we wish to draw attention to other disorders which may mimic the shaken baby syndrome.

In the first place coagulation disorders may have a similar presentation (4). They need to be investigated and, if present, treated urgently. A second disorder which may present in an identical manner to the shaken baby syndrome is hemophagocytic lymphohistiocytosis (HLH) (5,6). In a recent article Rooms et al. (5) report 3 cases showing that presentation of this disorder may be indistinguishable from the shaken baby syndrome. This rare disorder is caused by an abnormal proliferation of histiocytes in tissues and organs. It usually presents with fever, hepatosplenomegaly, pancytopenia, hypertriglyceridemia and coagulation disorders. However, it may also present with central nervous system manifestations ranging from irritability to encephalopathy and coma.

Clinical findings include retinal and intracranial haemorrhages. When untreated this disorder is fatal. Optimal treatment consists of allogeneic bone marrow transplantation and cytotoxic and immunosuppressive therapy.

The presence of anaemia, thrombocytopenia, abnormal liver enzymes and hepatosplenomegaly as well as coagulation disorders should raise suspicions of HLH. More extensive investigations including bone marrow aspiration, T2 weighted MRI scan of the brain, triglyceride and serum ferritine levels will be necessary to confirm the diagnosis.

As shown in the papers and ensuing correspondence in your journal, the impact for all concerned, of the diagnosis of shaken baby syndrome is enormous (7,8). Therefore it is essential that other possible causes are eliminated before this diagnosis is pronounced.

1. Geddes JF, Plunkett J. The evidence base for shaken baby syndrome. BMJ 2004;328:719-720

2. Harding B, Risdon RA, Krous HF. Shaken baby syndrome. BMJ 2004;328:720- 721

3. Lantz PE, Sinal SH, Stanton CA, Weaver Jr RG. Perimacular retinal folds from childhood head trauma. BMJ 2004;328:754-756

4. Vorstman EB, Anslow P, Keeling DM, Haythornwaite G, Bilolikar H, McShane MT. Brain haemorrhage in five infants with coagulopathy. Arch Dis Child 2003; 88: 1119-21

5. Rooms L, Fitzgerald N, McClain KL. Hemophagocytic lymphohistiocytosis masquerading as child abuse: presentation of three cases and review of central nervous system findings in hemophagocytic lymphohistiocytosis. Pediatrics 2003;111:e636-40

6. Hallahan AR, Carpenter Pa, O’Gorman–Hughes DW, Vowels MR, Marshall GM. Haemophagocytic lymphohistiocytosis in children J. Paediatr Child Health 1999; 35: 55-9

7. Minns RA, Busuttil A. Four types of inflicted brain injury predominate. BMJ 2004;328:766

8. LeFanu J, Edwards-Brown R. Subdural and retinal haemorrhages are not necessarily signs of abuse. BMJ 2004;328:767

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In The 1930's Scurvy Was Considered As The Cause Of Subdural Hematomas
Because Capillary Fragility Caused Bleeding In The Head.

http://tinyurl.com/3wepoz

By Stephen Lazoritz, Vincent J. Palusci

"Breast fed infants are notoriously immune to this disorder"--they are also nearly immune to infantile scurvy due to the large amount of vitamine C in breast milk. "now recogized as a classic case of child abuse"--these are classic signs of scurvy. "the edtiology of subdural hematoma was traumatic in most cases"--there was no proof of inflicted trauma, that was assumed due to the other symptoms. Subdural hematoma is common in scurvy.

"...led to the incorrect conclusion that scurvy predisposed these children to the condition" --A poor home environment would more likely result in nutritional deficiency due to a lack of fruit, fruit juice and vegetables high in vitamin C. "was thought to disrupt healing in the veins bridging the dura"--scurvy does result in brain hemorrhage, including subdural hematomsa, intraocular bleeding, retinal hemorrhage... "poor diet and traumatic head injury could occur as independent results of parental mistreatment" --poor diet and head injury could occur as a result of scurvy without inflicted injury. "The greatest advances in the identification of the Shaken Baby Syndrome..." --great disasters have resulted from the misdiagnosis of SBS which are actually infantile scurvy-endotoxemia due to a lack of differential diagnosis to eliminate disease as a cause.

"it was this dissatisfaction with convention wisdom.." --his dissatisfaction led to his lack of correct scientific method which must include eliminating other causes, and basing his theories on assumption without a solid scientific basis. "Caffey published his landmark article" --in his article he listed "scurvy" as a differential diagnosis but failed to eliminate it as a cause, and by-passed a needed peer-reviewed challenge to his findings, which were accepted by the public as an unproven theory which eventually became in an improper scientific manner accepted medical theory. "The medical evaluation of abusive trauma was born" --abusive trauma was never proven by reliable witnesses, only assumed, just as long bone fractures may have been caused by vitamin C deficiency, or may not have been fractures at all but callused subperiosteal hemorrhages which look the same on x-rays, and are indicative of scurvy. An analysis and commentary on the 6 cases he used are provided above, by undisputed vitamin C deficiency expert Dr. C.A.B. Clemetson, MD.

PURE FRAUD: "he showed that subdural hematoma could be caused by whiplash injury without impact" but what Caffey left out was the inhuman amount of force it required. Ommaya proved that it could be caused by a mechanical whiplash device, but determined the force required was around 155 g's. However, "Today, Mammoya is adamant that he told Caffey that acceleration-deceleration involved in the monkey experiment were much greater than he believed could be generated by a human."  (Military Law Review, Vol 188, P. 8)  Caffey seems to have ignored this warning and jumped ahead in accusing caretakers of inflicted trauma by shaking. Then, studies by Dr. Ann-Christine Duhaime demonstrated experimentally that humans could only produce around 9.3 g's of force, when around 155 g's were previously found to be required to produce even 1 of 2 symptoms (subdural hematomas or diffuse axonal injury), which meant that caretakers could not produce these injuries by shaking alone.

"That evening, Abbey Caspinov, 11 days old, didn't want to take her formula" --not wanting to eat (anorexia) is a key diagnostic symptom of scurvy, and the infant was on formula rather than breast feeding, which made if far more susceptible to vitamin C deficiency. The mother's history was not taken to see if she had a deficient diet, with an excess of coffee, sugar, or whether she smoked which would have created the conditions for prenatal scurvy. The condition may have preceded the shaking or been caused by birth trauma. Many infants have retinal hemorrhages, subdural hematoma, and fractures at birth. Or the shaking could have aggrevated prior injuries, or caused more damage in susceptible infants than would occur in a healthy infant, since primate studies indicate shaking alone can't cause the kind of head injuries in a normal infant that are attributed to shaken babies.